Immigrants – State of Healthhttps://ww2.kqed.org/stateofhealth
KQED Public Media for Northern CAThu, 08 Dec 2016 19:25:40 +0000en-UShourly1https://wordpress.org/?v=4.2.2Asking Mom: ‘Did You Know I Was Depressed In High School?’https://ww2.kqed.org/stateofhealth/2016/05/26/asking-mom-did-you-know-i-was-depressed-in-high-school/
Thu, 26 May 2016 17:07:44 +0000http://ww2.kqed.org/stateofhealth/?p=189291Rose has dealt with depression since high school. She’d put her head down, focus on school and get through. But during her senior year of college, Rose couldn’t even concentrate on school anymore.

“I was struggling. I was feeling depressed. I was feeling isolated,” Rose, now 24, says. “I was crying at Cheerios commercials, which is not normal.”

Rose started seeing a therapist and now feels like she has everything under control. She’s even on her way to becoming a therapist herself, in her third year of a Ph.D. program in clinical psychology. (We’re using first names only in this story to protect her patient-therapist relationships.)

She has never told her parents anything about her own depression. She worried about disappointing them. She also worried that her mental health issues were frivolous compared with the struggles that her parents, who grew up in Pakistan and emigrated to the United States, have endured.

And she was particularly worried about what her mom would say.

“So I had moved out for college, and that’s not really the norm for my cultural background,” Rose says. “I was afraid that I was going to share this with her and the response would be: ‘I told you it wasn’t good for you to move out. You should have stayed home.’ ”

A few weeks ago, Rose decided to take a huge step. In talking about this story, she realized this could be a good opportunity to tell her mother for the very first time about her struggles with depression. She got her mother’s permission to record the conversation:

Rose: I don’t think I’ve ever asked you how do you feel about my decision to be a psychologist?

Mama: Mmmm.

Rose: (Laughs.) Complicated feelings.

Mama: Yeah.

One of the reasons Rose was interested in sitting down with her mom for this story was because she plans to do her thesis on this very kind of thing. In general, children have trouble talking to their parents about mental health issues. But in Rose’s case, and for a lot of first-generation Americans, there’s not just the generation gap — there’s also a culture clash.

Rose: I know you’ve seen family that’s depressed. You’ve seen the symptoms like being cranky, sleeping a lot, not eating much. Those kind of things. Did you ever notice any of that in me when I was living here or even now?

Mama: No.

Rose: You never noticed any of that?

Mama: I don’t think you have any of this problem.

Rose: Well, it actually has been a problem for me.

Mama: I know, but I think this is no big problem.

Rose: OK. So, you’ve noticed those things but it’s not a big problem.

Mama: Yeah.

After that, Rose goes on for a while, explaining to her mom that she sort of hid her depression and maybe that’s why it didn’t look like a big problem.

Mama: You have depression, I understand. You live alone and nobody talk to you. And I know this is depression.

Rose: But you know I don’t think it’s because I live alone. Because I felt this way in high school when I lived here. This isn’t brand new.

Then Rose told her mother that she was worried that her mother would judge her.

Rose: I didn’t want you to think that I’m weak or … broken or anything like that. Do you think of me any differently?

Mama: No. I am proud of you, and you are the angel of our life.

Rose: So after this conversation, what, if anything, do you think is going to change?

Mama: You move here.

Rose: (Laughs.) I’m not moving here. I think you know that.

That conversation ended on what seemed like a pretty nice note. But then Rose shut the recorder off. At that point, she says, her mom got mad about Rose going public, and told her that she would have a harder time getting married because of it. Rose says now:

I tried to be like, that’s the point. That’s why we’re doing this. Because both in our American culture and in our Pakistani culture there’s a stigma, and she knows it. Because now she’s afraid that people are going to know this about me and judge me for it, and it’s going to make it harder to have a future the way she wants me to have a future.

She regretted having shared all this with her mom. But then, the next day, Rose’s mom started asking these little questions like, “Where did this start?” or “What could I have done differently?” Even, “Is this because I wouldn’t let you wear makeup to school?” Rose started to feel like her mom was coming from a place of wanting to understand better, rather than judging.

And with a little time, Rose found herself doing the same thing — trying to understand her mom’s reaction instead of judging it:

I’ve had years to come to terms with this knowledge about myself and I gave her, what, maybe an hour-long conversation and then expected her to, at the end of it, be totally understanding and calm and collected about it, which wasn’t fair on my part.

Rose thinks that sharing and being open about mental illness may ultimately bridge these kinds of generational and culture gaps.

But people have to be prepared for a process, she says, not a hit-and-run conversation.

Laying everything out has made her and her mom more reflective. So maybe it wasn’t such a bad idea after all.

The March 31 deadline to sign up for health insurance is now less than two weeks away. On Monday, enrollment on Covered California went over the 1 million mark. But there are literally millions more Californians currently uninsured.

Many of those eligible for benefits under the Affordable Care Act (ACA) are immigrants. If you are a lawfully present immigrant you likely qualify for the benefits — and responsibilities — of the ACA. This means if you do not sign up for insurance by March 31, you may have to pay a fine next year on your taxes. This is either $95 per adult or 1 percent of your income, whichever is greater. For example, if you earn $30,000 a year, you might have to pay a $300 fine.

On the flip side, you may qualify for a subsidy to help you purchase health insurance. You do not need a green card to qualify. There is a long list of visas under which immigrants might be lawfully present in the U.S. Check this list from the federal government to see if your immigration status or visa means that you can quality for benefits.

If you’re wondering how much you might pay for health insurance, Covered California has a cost calculator so you can estimate your premium. The cost calculator will also indicate if you are eligible for Medi-Cal.

Even if you make too much money to qualify for a subsidy, you can still purchase health insurance on the Covered California marketplace.

Seek Help in Person

Covered California is encouraging anyone who has questions about health insurance to talk to someone in person who can help them enroll. You can seek help from a certified enrollment counselor, your county’s human services agency or an insurance broker. You do not have to pay anything for these services, even from a broker. Many people helping — counselors, county employees or brokers — are fluent in languages besides English. Check this list from Covered California to see where you might go for help in your preferred language.

Health Insurance for Newly Arrived Aging Parents

The United States has had universal health insurance for nearly 50 years for some very specific people — those over 65 and some people who are disabled. These groups qualify for Medicare. But because of Medicare, there has not been an insurance market for immigrants over age 65. This meant that lawfully present immigrants or naturalized citizens had no way to provide health insurance for aging parents who sought to join their families in this country.

Editor’s note: For people buying on the individual market who want health insurance starting Jan. 1, the deadline to sign up is Monday, Dec. 23. State of Health is running one post a day with questions and answers on both the Affordable Care Act and Covered California until that deadline. This installment comes from KQED’s Obamacare Guide, written specifically for Californians.

The headline for immigrants is that if you are “lawfully present” (the legal term of art), you are eligible for the benefits — and responsibilities — of the Affordable Care Act. This means you may qualify for subsidies to purchase insurance, but it also means you may have to pay a penalty if you do not carry health insurance. While naturalized citizens and green card holders may be aware of how Obamacare affects them, for other immigrants, access to these kinds of benefits is new. Undocumented immigrants are not eligible for any benefits of the ACA. They do not have to pay a penalty if they do not carry health insurance.

I Am in the U.S. Legally, But I Do Not Have a Green Card. I Am Here under a Different Kind of Visa. What Does the Health Law Mean to Me?

U.S. law includes a wide variety of ways in which immigrants can be lawfully present, even if they are not green card holders.

The Affordable Care Act provides benefits to immigrants lawfully present under many different kinds of immigration status. You can check this list from the federal government to see if you qualify.

If your immigration status is one of those that makes you eligible for ACA benefits, here’s what you need to know:

Depending on your income and the number of people in your family, you may be eligible for subsidies to help you pay for insurance. If you earn less than 400 percent of poverty (about $46,000 for an individual or $94,000 for a family of four), you likely qualify for a sliding scale subsidy.

Covered California has a cost calculator so you can estimate how much you might have to pay for health insurance. The cost calculator will also indicate if you are eligible for Medi-Cal.

Even if you make too much money to qualify for a subsidy, you can still purchase health insurance on the Covered California marketplace.

I Am Lawfully Present and Want My Parents to Immigrate. Are They Eligible for Any Benefits?

If your parents are lawfully present, they are eligible to buy insurance on the Covered California marketplace. They may also be eligible for subsidies, depending on their income.

We Are a Mixed-Status Family. How Do We Handle Our Application?

A mixed-status family is a household of individuals present in the United States under different immigration or citizenship statuses. While undocumented immigrants are not eligible for benefits under the health law, lawfully present members of a mixed-status family likely are eligible for benefits. Please consult this document from the National Immigration Law Center.

Mohan Iyer has been in a bind. He’s lived in the U.S. since he came here for college from India in 1980. He ultimately got a job, a green card and became a citizen in 1994. Most of his siblings live here now, too.

After his father passed away two years ago, Iyer and his siblings have wanted their mother to move here. But there’s one big problem: she is effectively barred from any kind of reliable health insurance.

“Health care has been a big issue,” said Iyer, who is 50 and lives in Menlo Park.

New immigrants of any age can purchase health insurance on Covered California

That’s because new immigrants over age 65 are not eligible for Medicare. For legal immigrants like Iyer, who are people of working age, the impossibility of obtaining health insurance for their parents has been a barrier in their hopes of moving aging parents or grandparents to the U.S.

Americans over 65 tend not to worry much about health insurance, because of Medicare, the government insurance program for the elderly and the disabled. But while Medicare is available to virtually all citizens, starting at age 65, immigrants legally present in the U.S. for less than five years are not eligible.

And because of the very existence of Medicare, private insurance companies generally do not offer health insurance plans for those over 65. “There are health insurance options,” Iyer said, “but these are usually catastrophic traveler’s insurance. They usually have a very high deductible and they’re expensive.”

They also tend to exclude pre-existing conditions, he said.

“We’ve heard horror stories of elderly parents visiting their kids here, having a fall or a cardiac problem and the bill arrives in the range of $100,000.”

As our conversation went on, Iyer was clearly at a loss of what to do. “It’s one thing to say I’ll support my mom, and another to say I’m ready for a sudden, six-figure bill that I have to cover.”

I asked him if he was aware that immigrants, even those here less than 5 years (a big cutoff point in immigration policy) were eligible to purchase health insurance In the Covered California marketplace, the new exchange set up to comply with the Affordable Care Act.

Iyer lit up. “Oh, really? Wow, that is huge!” he exclaimed. “This has been something I’ve been sweating.” He said that finding peace of mind on this issue would be “a huge deal.”

Tanya Broder in the Oakland office of the National Immigration Law Center said there’s “a lot of confusion” about immigrants and the ACA. “Most of the outreach materials and most of the material online are directed at citizens.”

She pointed out that the ACA seems to make the presumption that most people over 65 are receiving Medicare.

“But there’s nothing prohibiting someone who is lawfully present in the U.S. but ineligible for Medicare or Medicaid from purchasing coverage in the exchange,” Broder said.

Obamacare provides new options for immigrants under age 65 as well. California is participating in the Medicaid expansion, called Medi-Cal in California. For the first time, individuals (citizens and legal immigrants alike) who do not have children and are not disabled can apply to the program, as long as their income is less than 138 percent of poverty, about $15,500. Immigrants must be here legally, but they do not need to have a green card.

We have more detail in our popular Obamacare Guide. Click on the “I am an immigrant” section.

“Have you heard of the program Obamacare?” Pena asked a group of patients. A few nodded. Others stared blankly.

As enrollment began around the nation, the scene at this Wesley Health Center underscored one of the major challenges facing officials – overcoming the lack of awareness.

Some had never heard of the new law and few knew that Oct. 1 was the first day of enrollment.

Nearly all of the patients in the crowded waiting room were Latino, including several first-generation immigrants. Some had never heard of the new law and few knew that Oct. 1 was the first day of enrollment.

“There are tons of people who don’t know what’s going on today,” said Valerie Lopez, an outreach worker at the center.

Pena explained to the patients at the health center that starting Tuesday, they could sign up for new health coverage that would begin Jan. 1. Depending on their income, they would either qualify for free insurance through Medicaid (called Medi-Cal here) or for discounted private insurance through Covered California, the state’s online health insurance marketplace. And she warned about the penalty that most people who don’t have insurance would face in 2014.

The patients asked many questions: Do I have to pay a fine if I am not working? Do I still qualify for Medi-Cal if I own a home? Are there people to help me fill out the application? Pena didn’t know all the answers, but she said people would be available soon to help with enrollment. There was no one at the center who could actually help people enroll. They are still being trained.

The Obama administration is counting on outreach efforts to enroll Latinos and other immigrants. They tend to be younger than the general population, and so they balance out the costs of older, sicker people in the insurance pool.

Getting the information out to immigrants is an uphill battle, said Reshma Shamasunder, executive director of the California Immigrant Policy Center. Many speak little or no English. They also may live in mixed-status families, where some are eligible for new insurance options and others aren’t. And after years of deportations throughout immigrant communities, the distrust of government is high, she added.

“It is going to be important to have trusted messengers in their communities,” she said.

Health clinic administrators say they hope their staff members will be those messengers. “Once patients establish that rapport and that trust, they are going to look for us for information,” said Frances Bernabe, director of clinic operations for the Wesley Health Centers.

Even if they are successful with their outreach efforts, California officials know millions could remain uninsured. A UC Berkeley study last year found that as many as 4 million Californians could still be without insurance in 2019 and nearly three-quarters will be U.S. citizens or legal residents. Two-thirds remaining uninsured will be Latino.

About 1 million of those remaining uninsured will be immigrants not in the country legally, the study said. The law bars undocumented immigrants from getting insurance from the exchanges, even if they pay for it themselves.

Celia Figueroa limped into the Bell Gardens clinic early Tuesday morning, hoping to see a doctor about a lingering pain in her knee. A doctor told her years ago that she needs surgery but Figueroa said she can’t afford it.

Figueroa, 57, who is uninsured, said she has heard of the health law but doesn’t know what it does or if she qualifies for it. “I don’t know anything about Obamacare,” she said.

Monica Delgado, 32, listened to the presentation by the outreach workers but knew none of it applied to her because she is in the country illegally. Delgado, who works as a housekeeper, said she feels frustrated that she can’t take advantage of the new coverage options.

“This is unequal because it’s not for everybody,” she said. “But everybody gets sick.”

Delgado came to the clinic Tuesday morning because her daughter, who is covered by Medi-Cal, had a spider bite. Without insurance, she said she would continue relying on the clinic, where she can get care for free.

In an effort to get the word out to Latinos, Covered California is running ads in both English and Spanish, and officials have translated information about the new insurance options into Spanish.

Covered California has also awarded millions in grants to organizations working with Latinos and other ethnic groups to help people to enroll.

On Monday afternoon at another Los Angeles clinic, St. John’s Well Child & Family Center, Maria Gomez, 58, said she pays in cash when she goes to the doctor or has to buy medication. Gomez, a legal resident from Mexico, came to the center for more information about the health law.

When she learned she would be eligible for expanded Medi-Cal coverage, she said. “Finally, I am going to have insurance. I feel happy.”

Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the Kaiser Family Foundation.